Provider Demographics
NPI:1760416374
Name:CROWE, CHERYL B (OT)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:B
Last Name:CROWE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6001
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58108-6001
Mailing Address - Country:US
Mailing Address - Phone:701-364-8000
Mailing Address - Fax:701-364-8078
Practice Address - Street 1:3000 32ND AVE S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-6132
Practice Address - Country:US
Practice Address - Phone:701-364-8000
Practice Address - Fax:701-364-8078
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND687225X00000X, 225XE1200X, 225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XE1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistErgonomics
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND18210OtherNDBS #
NDHP33434OtherHEALTHPARTNERS #
ND51602Medicaid
ND60G80CROtherMNBS #
NDDA9011015523OtherPREFERRED ONE #
ND21954OtherNDBS #
ND974267OtherAMERICA'S PPO/ARAZ #
ND6401675OtherMEDICA #
ND6402287OtherMEDICA #
ND70D29CROtherMNBS #
ND6403824OtherMEDICA #
ND21954OtherNDBS #
ND60G80CROtherMNBS #
ND21954Medicare ID - Type UnspecifiedRR MEDICARE #
ND51602Medicaid